MEDICARE: DR. GARY LYNN GOTSCH D.D.S, M.S.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	7341	IN
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174627749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY LYNN GOTSCH D.D.S, M.S.D.

Provider Business Mailing Address
First Line	:	4205 HOBSON CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-8648
Country	:	US
Telephone Number	:	260-486-8778
Fax Number	:	260-486-7679

Provider Business Practice Location Address
First Line	:	4205 HOBSON CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-8648
Country	:	US
Telephone Number	:	260-486-8778
Fax Number	:	260-486-7679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	10/11/2016

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